News|Articles|November 12, 2026

Evolving Multiple Myeloma Care: What Nurses Need to Know About an Innovative Treatment Approach in Subcutaneous Administration

Sponsored by Sanofi

About the Featured Contributors:

Donna Catamero, ANP-BC, OCN, CCRC, Associate Director, Myeloma Research, Adjunct Faculty, Mount Sinai Phillips School of Nursing and International Myeloma Foundation Nurse Leadership Board member. Donna has been compensated for her time.

Yvonne Barnes, DNP, CPNP, Senior Medical Director, US Medical Head-Hematology/Oncology, Sanofi.

The multiple myeloma treatment landscape has seen remarkable advancements in recent years, offering patients more options and improved outcomes. Yet, the journey for patients often involves unique burdens, from time-consuming travel to treatment centers and lengthy clinical visits, to the emotional toll of ongoing care. For oncology nurses, those same factors influence workflow, staffing, and the amount of time available for direct patient support.

In this conversation, Donna Catamero, a dedicated oncology nurse practitioner specializing in myeloma research, and Yvonne Barnes, US Medical Head of Hematology and Oncology at Sanofi, discuss what practical innovation can look like in multiple myeloma care and how alternative administration options, like subcutaneous (SC) administration via an on-body injector (OBI), may impact both patients and clinical workers.

Understanding the Multiple Myeloma Burden

Barnes: As a nurse practitioner, Donna, you are on the front lines of care, witnessing firsthand the daily realities for patients. What are the most pressing unmet needs and challenges you observe in treating multiple myeloma today?

Catamero: While new therapies have been transformative, the practical aspects of treatment administration can still present significant challenges. One of the biggest unmet needs I see is the amount of time and energy treatment can require. In cancer care, there is so much time lost for patients, as they often can spend considerable periods in the clinic for intravenous infusions, which can heavily impact their personal schedules, work, and family life. Even when the treatment plan is working clinically, the cumulative effect of frequent clinic visits, administration time, and post-treatment recovery can wear patients down.

There is also the heavy burden that comes with the uncertainty and chronic nature of multiple myeloma. Patients are often balancing treatment with ongoing monitoring and the emotional strain of living with cancer that can require long-term continuous therapy, traditionally spanning multiple years.

Barnes: And, unfortunately, patients aren’t the only ones impacted by these challenges, correct?

Catamero: Absolutely. From a nursing perspective, the administration of complex intravenous therapies can be time-consuming, often pulling us away from direct patient engagement, deeper conversations about their overall well-being and ongoing education. This creates a real challenge in providing holistic care.

We are with patients at every step of their journey, so the patient experience is deeply connected to what nurses encounter behind the scenes. When nurses can find ways to modify their workflow at their institution, they may find time that they can give back directly to patients—to do a more thorough assessment, have a more focused conversation with the patient, or catch up on other vital parts of their clinical documentation and care coordination.

The First Available Oncologic Treatment Administered Via On-Body Injector

Catamero: All that said, I understand there is an FDA-approved subcutaneous therapy available for administration with an OBI that could offer a different approach for multiple myeloma treatment.

Barnes: You’re referring to the US FDA approval of subcutaneous Sarclisa Escena™ (isatuximab-irfc) in combination with standard-of-care regimens for the treatment of adult patients with multiple myeloma.¹ What’s unique about this formulation is that it’s the first oncologic treatment approved for administration by a healthcare professional with CirCLIQ™, a hands-free, automated injector that eliminates the need for a continuous manual push.

Sarclisa Escena is indicated:

in combination with bortezomib, lenalidomide, and dexamethasone, for the treatment of adult patients with newly diagnosed multiple myeloma who are not eligible for autologous stem cell transplant (ASCT)
in combination with carfilzomib and dexamethasone, for the treatment of adult patients with relapsed or refractory multiple myeloma who have received 1 to 3 prior lines of therapy
in combination with pomalidomide and dexamethasone, for the treatment of adult patients with multiple myeloma who have received at least 1 prior line of therapy including lenalidomide and a proteasome inhibitor

Please see below for full Sarclisa Escena Important Safety Information and Prescribing Information.

The CirCLIQ OBI, approved for use with Sarclisa Escena, was designed to transform subcutaneous delivery. It uses a retractable 30g needle that is shorter and thinner than commonly used large-volume injection needles. In fact, the patient should never even see the needle during the injection. Further, because the device is automatic and hands-free, it eliminates the need for a continuous manual push during administration, giving nurses more capacity to focus their time and attention on their patients.

Catamero: Given the volume of patients we see every day, this method of administration could create an entirely different treatment experience for nurses. What led your team to pursue this specific combination for multiple myeloma?

Barnes: We’ve had many conversations with patient advocacy organizations, professional societies, healthcare providers, and nurses like yourself that have echoed many of the challenges you spoke to earlier—time constraints, patient concerns and the ability to engage with patients. We took that feedback seriously and made the decision to invest in a clinical program that could help us pioneer alternative options that could potentially make a meaningful difference in care. Through our partnership with Enable Injections, the developer and manufacturer of the CirCLIQ device, we collaborated on the development of an OBI specifically for Sarclisa Escena.

Integration, Education, and the Future of Care

Barnes: But, as with any innovation in oncology, implementation can take time, especially for community oncology centers managing busy workloads. What’s top of mind for you when it comes to integrating advancements into your workflow, and how can partners, like Sanofi, support you when it comes to education and adoption?

Catamero: For me, the most important thing partners like Sanofi can do is support nurses with accessible, hands-on education. Nurses need to feel comfortable with a device before they use it on a patient, understanding how it attaches, how it functions, and what to do if something unexpected occurs. Beyond the mechanics, sharing clinical evidence and real-world experience in a format that's practical for busy teams goes a long way.

Looking ahead, I think there's a part of this story that is still unfolding. What excites me most about innovations like this is what they make possible, not just in terms of efficiency, but in terms of what care could feel like when we take a different approach in administration. There's a real opportunity to reimagine the patient's experience in the clinic, and what that means for the relationship between nurse and patient.

IMPORTANT SAFETY INFORMATION

CONTRAINDICATIONS

SARCLISA ESCENA is contraindicated in patients with severe hypersensitivity to isatuximab-irfc or to any of its excipients.

WARNINGS AND PRECAUTIONS

Hypersensitivity and Other Administration Reactions

SARCLISA ESCENA can cause both systemic administration reactions (SARs), including severe or life-threatening reactions, and local injection-site reactions (ISRs).

Systemic Administration Reactions

In a pooled safety population of 411 patients with multiple myeloma who received SARCLISA ESCENA in combination with pomalidomide and dexamethasone (Pd); carfilzomib and dexamethasone (Kd); and bortezomib, lenalidomide, and dexamethasone (VRd) (IRAKLIA, IZALCO, and IsaSocut, respectively, N=411), SARs occurred in 3.2% (Grade 1: 2.2%, Grade 2: 0.7%, Grade 3: 0.2%) of patients. SARs occurred at the first administration in 1.9% of patients and at subsequent administrations in 1.5% of patients. The median time to onset was 4 hours (range: 12 minutes to 3 days). The most frequently reported symptoms of SARs (all below 1%) were pyrexia and dyspnea, and the most frequently reported Grade ≥3 symptom was dyspnea (not collected in IsaSocut study). In multiple myeloma clinical trials with intravenous isatuximab-irfc, anaphylactic reactions occurred in <1% of patients.

To decrease the risk and severity of SARs, premedicate patients prior to SARCLISA ESCENA administration with leukotriene receptor antagonists (at cycle 1 only), acetaminophen, diphenhydramine or equivalent, and dexamethasone.

In case of grade 2 SAR during SARCLISA ESCENA administration, stop current administration and do not complete it. Administer additional premedication, as needed, for subsequent SARCLISA ESCENA administration. In case of grade 3 SAR during SARCLISA ESCENA administration, stop current administration and do not complete it. SARCLISA ESCENA administration may be resumed at the next planned administration. In case of a third occurrence of a grade 3 SAR, permanently discontinue SARCLISA ESCENA treatment. In case of grade 4 SAR, permanently discontinue SARCLISA ESCENA treatment.

Injection Site Reactions

In clinical trials of SARCLISA ESCENA in combination with Pd, Kd, or VRd (IRAKLIA, IZALCO, and IsaSocut, respectively, N=411), injection site reactions (ISRs) with SARCLISA ESCENA administration were reported in 9% (8% Grade 1 and 1.5% Grade 2) of patients and in 0.86% of injections. Among the SARCLISA ESCENA injections with ISRs, 82% occurred the day of the administration and 4.2% were delayed by at least 3 days. With SARCLISA ESCENA + Pd and SARCLISA ESCENA + Kd, 5% of patients experienced symptoms of ISR (not collected in IsaSocut study). The most frequent (≥1%) symptoms of ISR were injection site erythema (3.3%), injection site swelling (2.1%), and injection site pain (1.5%).

In case of grade 2 ISR during administration of SARCLISA ESCENA, interrupt it and resume it only after recovery to grade ≤1 with pauses during the administration (if using OBDS) or a slower administration (if manual injection). If the Grade 2 ISR occurs after the administration, continue SARCLISA ESCENA treatment after recovery to grade ≤1. In case of grade 3 or 4 ISR, permanently discontinue SARCLISA ESCENA treatment.

In case SARCLISA ESCENA administration using CirCLIQ OBDS needs to be paused, refer to the OBDS Instructions for Use.

Neutropenia

Neutropenia was reported in patients receiving SARCLISA ESCENA subcutaneously in combination with Pd, Kd, or VRd. In clinical trials of SARCLISA ESCENA (IRAKLIA, IZALCO, and IsaSocut, N=411), neutropenia occurred in 86% of patients based on laboratory value. Grade 3-4 neutropenia occurred in 66% of patients based on laboratory value. Febrile neutropenia was reported in 3.4% and neutropenic infections occurred in 13% of patients.

Monitor complete blood cell counts periodically during treatment. Monitor patients with neutropenia for signs of infection. In case of grade 4 neutropenia, delay or omit SARCLISA ESCENA dose until neutrophil count recovery to at least 1 x 10⁹/L, and provide supportive care with growth factors, according to institutional guidelines.

Infections

SARCLISA ESCENA can cause severe, life-threatening, or fatal infections. In patients who received SARCLISA ESCENA subcutaneously in combination with Pd, Kd, or VRd (IRAKLIA, IZALCO, and IsaSocut, respectively, N=411), fatal infections occurred in 2.9% of patients, serious infections occurred in 29% of patients, and Grade ≥3 infections occurred in 29% of patients. The most commonly reported infections (≥10%) were pneumonia (21%), upper respiratory tract infection (19%), and COVID-19 (12%). The most frequent serious infection (≥5%) was pneumonia (17%).

Patients receiving SARCLISA ESCENA should be closely monitored for signs of infection and appropriate standard therapy instituted.

Antibacterial and antiviral prophylaxis (such as herpes zoster prophylaxis) should be considered during treatment.

Second Primary Malignancies

Second primary malignancies were reported in 3.9% of patients in clinical trials with SARCLISA ESCENA in combination with Pd, Kd, and VRd (IRAKLIA, IZALCO, and IsaSocut, respectively, N=411).

Monitor patients for the development of second primary malignancies and initiate treatment as indicated.

Laboratory Test Interference

Interference with Serological Testing (Indirect Antiglobulin Test)

Isatuximab-irfc binds to CD38 on red blood cells (RBCs) and may result in a false-positive indirect antiglobulin test (indirect Coombs test). This interference with the indirect Coombs test may persist for at least 6 months after the last administration of intravenous isatuximab-irfc. The indirect antiglobulin test was positive during intravenous isatuximab-irfc + Pd treatment in 68% of the tested patients, and during intravenous isatuximab-irfc + Kd treatment in 63% of patients. In patients with a positive indirect antiglobulin test, blood transfusions were administered without evidence of hemolysis. ABO/RhD typing was not affected by intravenous isatuximab-irfc treatment.

Before the first isatuximab-irfc administration, conduct blood type and screen tests on isatuximab-treated patients. Consider phenotyping prior to starting isatuximab-irfc treatment. If treatment with isatuximab-irfc has already started, inform the blood bank that the patient is receiving isatuximab-irfc, and isatuximab-irfc interference with blood compatibility testing can be resolved using dithiothreitol-treated RBCs. If an emergency transfusion is required, non–cross-matched ABO/RhD-compatible RBCs can be given as per local blood bank practices.

Interference with Serum Protein Electrophoresis and Immunofixation Tests

Isatuximab-irfc is an IgG kappa monoclonal antibody that can be incidentally detected on both serum protein electrophoresis and immunofixation assays (IFE) used for the clinical monitoring of endogenous M-protein. In patients with persistent very good partial response, where interference is suspected, consider using a validated isatuximab-specific IFE assay (Sebia Hydrashift) to remove isatuximab-irfc interference and specifically visualize any remaining serum M-protein, to facilitate determination of complete response.

Embryo-Fetal Toxicity

Based on its mechanism of action, isatuximab-irfc can cause fetal harm when administered to a pregnant woman. Isatuximab-irfc may cause fetal immune cell depletion and decreased bone density. Advise pregnant women of the potential risk to a fetus. Advise females of reproductive potential to use effective contraception during treatment with isatuximab-irfc and for 7 months after the last dose. The combination of isatuximab-irfc with pomalidomide or lenalidomide is contraindicated in pregnant women because pomalidomide or lenalidomide may cause birth defects and death of the unborn child. Refer to the pomalidomide or lenalidomide prescribing information on use during pregnancy.

ADVERSE REACTIONS

In combination with pomalidomide and dexamethasone: The most common adverse reactions (≥20%) are upper respiratory tract infection, fatigue, pneumonia, musculoskeletal pain, and diarrhea.

In combination with carfilzomib and dexamethasone: The most common adverse reactions (≥20%) are upper respiratory tract infection and musculoskeletal pain.

In combination with bortezomib, lenalidomide, and dexamethasone: The most common adverse reactions (≥20%) are peripheral neuropathy, constipation, diarrhea, fatigue, musculoskeletal pain, upper respiratory tract infections, injection site reaction, insomnia, edema, rash, and erythema.

The most common hematology laboratory abnormalities (≥40%) with SARCLISA ESCENA combination therapies are decreased neutrophils, decreased platelets, decreased hemoglobin, decreased leukocytes, and decreased lymphocytes.

Serious adverse reactions occurred in 53% of patients receiving SARCLISA ESCENA + Pd. Serious adverse reactions in ≥5% of patients who received SARCLISA ESCENA + Pd included pneumonia (20.5%). Fatal adverse reactions occurred in 4.9% of patients who received SARCLISA ESCENA + Pd, including pneumonia (1.5%), sepsis/septic shock (1.5%), death (0.8%), COVID-19, lower respiratory tract infection, hemorrhagic stroke, and sudden death (0.4% each).

Serious adverse reactions occurred in 41% of patients receiving SARCLISA ESCENA + Kd. Serious adverse reactions in ≥5% of patients included pneumonia (11%). Fatal adverse reactions occurred in 5.4% of patients who received SARCLISA ESCENA + Kd, including meningitis (1.4%), acute pulmonary edema (1.4%), acute respiratory distress syndrome (1.4%), and death from unknown cause (1.4%).

Serious adverse reactions occurred in 45% of patients who received SARCLISA ESCENA + VRd. Serious adverse reactions in >5% of patients included pneumonia (8%). Fatal adverse reactions occurred in 2.7% of patients who received SARCLISA ESCENA + VRd, including cardio-respiratory arrest (1.4%) and myocardial infarction (1.4%).

USE IN SPECIAL POPULATIONS

Based on its mechanism of action, SARCLISA ESCENA can cause fetal harm when administered to a pregnant woman. There are no available data on SARCLISA ESCENA use in pregnant women to evaluate for a drug-associated risk.

The combination of SARCLISA ESCENA and pomalidomide or lenalidomide is contraindicated in pregnant women because pomalidomide and lenalidomide may cause birth defects and death of the unborn child. Refer to the pomalidomide or lenalidomide prescribing information on use during pregnancy. Pomalidomide and lenalidomide are only available through a REMS program.

Because of the potential for serious adverse reactions in a breastfed child, advise patients not to breastfeed during treatment with SARCLISA ESCENA and for 7 months after the last dose.

Please see accompanying full Prescribing Information.

References

SARCLISA ESCENA^® Prescribing Information. Sanofi Corporation; Cambridge, MA. July 2026. Available at: https://products.sanofi.us/sarclisa-escena/sarclisa-escena.pdf

Sanofi developed and sponsored this article.

This article is not intended to replace professional medical advice. Healthcare professionals should consult the complete prescribing information when considering treatment options.

For US HCP Audiences Only.

MAT-US-2611147-v1.0-11/2026

Sarclisa Escena and Sanofi are trademarks of Sanofi or an affiliate. All other trademarks are the property of their respective owners.